Sun Nov 04, 2012 at 11:06:25 AM EST

I wipe butts for a living, as some of you know. In fact, I'm wiping butts this afternoon, to the tune of about $9 an hour. I've done it for a little more than five years now, and I'm at the ceiling of what wage I can earn as a mere butt wiper. Sometimes it's an easy and even fun job. Others, like when you have to clean the spillage from a ruptured colostomy bag off someone, it's considerably less pleasant. But, I can tell you that it is mostly rewarding work, because at the end of the day it matters.

Proposal 4 isn't about me. I wipe butts in a group home. Proposal 4 is for those people who wipe butts but work for individual clients. Some of them, many of them, are family members caring for sons, daughters, brothers, and sisters. Others are simply people who can't get by on their own without help from someone else. It's when they lose that ability for independence that they wind up living in places where I work, and in nursing homes.

I'm pretty fortunate in that I feel like I'm mostly adequately trained to do my job. I am CPR qualified, and receive annual refresher training on medication passing protocols and in other things. When special circumstances arise, my employer makes it a point to make sure I understand what new tasks I have to perform. For instance, a few years ago, one of the people had a serious infection, and because hospitals like to discharge Medicaid patients as quickly as possible (because cuts to Medicaid and Medicare reimbursements are currently below the cost of care, they're a financial burden on health care providers), I was trained in how to flush his IV line (called a picc) with saline to prevent it from closing.

The people who live in their homes and have someone come to take care of them aren't always so fortunate. Sometimes they don't have family members to do the job, and have to hire someone. There are sometimes resources available to help them do that, but you know, sometimes there aren't.

A few years ago, an agreement by the state with a couple of agencies sought to change that by creating a worker registry. It sought to replace a list that people in need could obtain, a list that was often out-of-date and incomplete, with a registry of people. The agreement also laid out that people who wanted to be on the registry go through a background check and that training be available. It's pretty no-brainer stuff.

There as a hitch, however. Part of the agreement held that the in-home workers be considered state employees and were enrolled in SEIU as a result. If I'm not mistaken, this even included family members.

It's not much of a hitch, frankly, but it sent the rightwing into the rafters. The Mackinac Center referred to it as a union money grab and eventually convinced the Legislature that it needed to stop it ... and along the way cutting the funding for the registry created. It was all pretty stupid.

So, now it's on the ballot as a constitutional amendment, and that's why I can't offer unqualified support for it. Unlike Proposal 3, the problem of training and background checks and advocacy on behalf of in-home workers isn't an imminent, civilization-level looming catastrophe. The Legislature can't really be trusted to handle it, because the Legislature can't be trusted to handle much, but the oceans won't boil if this isn't enshrined into the constitution (as we saw last week, the oceans can and will incresingly boil up in increasingly powerful rages the more carbon dioxide we pump into the atmosphere). More on this in a second.

As for the SEIU "union money grab," you can wave that off. It's just dumb. I've read and heard that there is no place for collective bargaining in this sort of environment. That's just not true. Wage levels for this work aren't just set by the family doing the hiring, because some of it is written right into Medicaid. In fact, it's the last item in the wording of Proposal 4. There are other things, too, like negotiating access to things like health screenings and treatments for communicable diseases like Hepatitis C and staph infections, things that you might be exposed to on the job.

More than anything, however, Proposal 4 starts us on the path towards reconceptualizing what is meant by organized labor. Our concept of organized labor is still rooted in 1940s thinking, of big factories and big labor forces and nation-crippling strikes. This offers us an opportunity to see a union as a sort of service organization for non-professional workers that provides services in a way that a human resources department does at a large corporation.

That includes training, and that means making available to people seeking help information about who on that registry is best trained to help them. I have a lot of sympathy for people who are family members and the amount of red tape they need to cut to provide care to family members. I have a lot of sympathy for family members who say they just want to take care of kids and siblings and parents, and aren't interested in registries or training or unions. These people are already dealing with serious enough problems without piling on top of it politics. It's unfortunate, in fact, that the thing got politicized in the first place. You can thank the Mackinac Center for that.

Fortunately, those people are allowed to mostly opt out of things, except nominal membership in the union. That means union dues, which could be alleviated by simply raising Medicaid reimbursement ceilings enough to cover it. So there is that. But, even those people ought to have resources available for changes in health. Put another way, all the love in the world ain't gonna flush someone's catheter hose. That requires someone who's been trained in how to do it.

It's important to consider the backdrop to all of this, which is that home care providers are being asked to do increasingly difficult things, things that tax not only skill levels but confidence. It's common for people to be intimidated by new tasks. It's especially common when you realize that doing it wrong might really hurt someone else. But, because state and federal governments have cut government health programs over the years, that's just what's happening. More people are receiving more care in their own homes. It's a good thing, but qualified as that it isn't if the people hired to do it are unreliable and unskilled. The registry's a good thing, and it gives us an opportunity to reimagine what a labor union does. It ought to be done in the Legislature, but that body has demonstrated a lack of aptitude and basic competence in the job. So, the question comes down to whether you want to see it done properly but imperfectly from a governance perspective, or not done at all.

Personally, I'm not as sold on Proposal 4 as I am on 3, but probably I'll vote yes. Tallied up, that's vote yes on 1, 3, probably 4. Vote no on 5, 6.